Al-Jiffry Bilal O, Khayat Samah, Abdeen Elfatih, Hussain Tasadooq, Yassin Mohammed
Dr. Bilal Omar Al-Jiffry, Taif University, Department of Surgery, College of Medicine and Medical Sciences, PO Box 888 Taif 21947, Saudi Arabia,
Ann Saudi Med. 2016 Jan-Feb;36(1):57-63. doi: 10.5144/0256-4947.2016.57.
Techniques for diagnosing choledocholithiasis pose significant morbidity and mortality risks.
We aimed to develop and validate a clinical scoring system for predicting choledocholithiasis.
Data from a prospectively maintained database of all patients with gallstones.
Patients were admitted to the general surgery department of a military hospital.
We enrolled consecutive patients with symptomatic gallstones, biliary pancreatitis, obstructive jaundice, or cholangitis, who subsequently underwent biochemical testing and ultrasonography. A predictive model was developed from a scoring system using their imaging and laboratory data. Endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography were used for confirmatory diagnoses. The predictive efficacy of the scoring system was validated using a retrospective cohort of 272 patients.
Predictive accuracy of the scoring system.
We enrolled 155 patients in the development group. The common bile duct diameter, alkaline phosphatase of >=200 IU, elevated bilirubin levels, alanine transaminase of >=220 IU, and male age of >=50 years were significantly associated with choledocholithiasis and were included in the scoring system. Ninety-six patients (35%) had scores of >=8 (high risk), 86 patients (32%) had scores of 4-7 (intermediate risk), and 27 patients (10%) had scores of 1-3 (low risk). In the validation cohort, the positive predictive value for a score of >=8 was 91.7%, and the scoring system had an area under the curve of 0.896.
Scores of >=8 were strongly correlated with choledocholithiasis in the developmental and validation groups, which indicates that our scoring system may be useful for predicting the need for therapeutic ERCP. However, prospective validation in a large multicenter cohort is needed to fully understand the benefits of the system.
The retrospective validation cohort might have introduced selection and observational biases. The study may have been underpowered because of the sample size of the developmental cohort. The delay between admission and the time of ERCP theoretically may have increased the number of negative ERCP results, but our false negative rate for ERCP was consistent with the previously reported rates.
诊断胆总管结石的技术存在显著的发病和死亡风险。
我们旨在开发并验证一种用于预测胆总管结石的临床评分系统。
来自前瞻性维护的所有胆结石患者数据库的数据。
患者入住一家军队医院的普通外科。
我们纳入了有症状胆结石、胆源性胰腺炎、梗阻性黄疸或胆管炎的连续患者，这些患者随后接受了生化检测和超声检查。使用他们的影像学和实验室数据从评分系统开发出一个预测模型。通过内镜逆行胰胆管造影（ERCP）或术中胆管造影进行确诊。使用272例患者的回顾性队列验证评分系统的预测效能。
评分系统的预测准确性。
我们在开发组纳入了155例患者。胆总管直径、碱性磷酸酶≥200 IU、胆红素水平升高、丙氨酸转氨酶≥220 IU以及男性年龄≥50岁与胆总管结石显著相关，并被纳入评分系统。96例患者（35%）评分≥8（高风险），86例患者（32%）评分4 - 7（中度风险），27例患者（10%）评分1 - 3（低风险）。在验证队列中，评分≥8的阳性预测值为91.7%，评分系统的曲线下面积为0.896。
在开发组和验证组中，评分≥8与胆总管结石密切相关，这表明我们的评分系统可能有助于预测治疗性ERCP的需求。然而，需要在大型多中心队列中进行前瞻性验证以充分了解该系统的益处。
回顾性验证队列可能引入了选择和观察偏倚。由于开发队列的样本量，该研究可能效力不足。理论上，入院与ERCP时间之间的延迟可能增加了ERCP阴性结果的数量，但我们的ERCP假阴性率与先前报道的率一致。
